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This form enables visitors to www.omh.ny.gov to submit information to OMH by UNSECURE EMAIL. E-mail sent to OMH through this site is not secure, so visitors should NOT transmit personal or medical information about themselves or other persons using this function. OMH CANNOT GUARANTEE THE PROTECTION/ INACCESSIBILITY BY OTHERS OF INFORMATION INCLUDED ON THIS FORM AND SENT TO OMH.

This form enables visitors to www.omh.ny.gov to submit information to OMH by UNSECURE EMAIL. E-mail sent to OMH through this site is not secure, so visitors should NOT transmit personal or medical information about themselves or other persons using this function. OMH CANNOT GUARANTEE THE PROTECTION/ INACCESSIBILITY BY OTHERS OF INFORMATION INCLUDED ON THIS FORM AND SENT TO OMH.